Pediatric Behavioral Mental Health: Cultivating Resilience
produced by Catherine Coughlin, Daniel O'Meara, Katelin
Blackburn, and Brenna Chase.
Pediatric Behavioral Mental Health: Cultivating Resilience.
After watching this video, learners will be able to
distinguish among positive, tolerable and toxic stress and
to help families implement strategies to foster resilience
using the COVID-19 pandemic as a brief illustration.
Topics of discussion. First, defining stress. Stress is a
fact of life. We take it with us everywhere. There are three main
types of stress: positive stress, tolerable stress, and
toxic stress. The first type is positive stress. Examples of
positive stress include giving a presentation, studying for a
test, or competing in a playoff game. This type of stress often
promotes an adaptive response and is a healthy part of
development. There is also tolerable stress. This type of
stress can be mitigated by the effects of an adult's
intervention and results in brain recovery. Examples include
moving to a new school, losing a loved one, or experiencing a
natural disaster. The third type is toxic stress. Toxic stress
can be relentless and challenging. Toxic stress can
occur when a child experiences strong, frequent, and or
prolonged adversity, such as physical or emotional abuse,
chronic neglect, caregiver substance abuse or mental
illness, exposure to violence, and/or the accumulated burdens
of family economic hardship without adequate adult support.
When humans experienced stress, we tend to have both an
emotional and physiological response. To modulate these
responses successfully, and to overcome the stressor,
resilience is essential. But what is resilience? Defining
resilience. Resilience is one's capacity to progress through
traumatic event using protective factors for support and
returning to an emotional and physiological baseline. When
children experience a stressful event, we want them to possess
the resilience necessary to overcome the stressor. Why does
resilience matter? Research shows that the prevalence of
common childhood conditions, poor childhood health, and
school absenteeism, all increased with a number of
adverse childhood experiences or toxic stress. Fortunately,
protective factors help prevent toxic stress, improve health
outcomes, and empower children to grow into healthy adults. How
do children develop resilience? A starting place is building
protective factors. Protective factors can come in the form of
parental reassurance, social support, or internal strength.
fostering growth in these areas empowers children to stabilize
in times of stress, improving their own internal strengths,
and learning to utilize external support.
Resilience. This combination of internal strength and external
supports provides a buffer between a child and a traumatic
event hoping to mitigate the effects of toxic stress.
Additionally, the protective factors that contribute to
resilience may not only prove useful during times of stress,
they may also help a child to excel during stress free seasons
of life. So building protective factors can be beneficial no
matter the individual and no matter the present situation.
Strategies to foster resilience. So how can parents build
resilience in children? Pediatrician W. Thomas Boyce and
his best selling book: "The Orchid and the Dandelion: Why
Some Children Struggle and How All Can Thrive," provides the
following guidance for parents and caregivers. One, providing
routine and consistency, two, parent's unwavering care and
attention, three, respecting the goodness of human differences,
four, unconditional acceptance and validations of the child's
true self, five, provision of a safe space while encouraging
controlled risk-taking, and six, valuing play. He concludes that
orchid children, who are highly susceptible to the character of
their environments, have more powerful responses to not only
negative experiences, but also positive supportive conditions.
Let's explore the formation of protective factors. How about
parental reassurance? What does that look like? Parents can
offer encouragement and positive reinforcement, provide space for
thoughtful discussion of children's struggles, and allow
time for kids to ask questions. Anytime a parent praises a child
for studying hard for an upcoming test, recognizes them
doing something nice for another person, or encourages them to
persevere through struggle, they are providing their child with
the growth opportunity in confidence and resilience.
What about social support as a protective factor? Social
support can come from a wide network of entities, which
includes schools, religious organizations, community
organizations, athletic teams, clubs, immediate and extended
family, and friends. Social support can be divided into four
sub-categories: emotional support, tangible support,
informational support, and companionship support. Emotional
support involves love, empathy, trust, affection, intimacy, and
encouragement offered by individuals and social groups.
This support lets the child know they're valued through warmth,
attention, and nurturance. Tangible support is the
provision of financial assistance, material goods or
services, also called instrumental support. This form
of social support comprises the concrete, specific ways we can
assist children and families. Informational support
encompasses the provision of advice, guidance, suggestions,
or useful knowledge to someone. This type of information has the
potential to help children problem solve, which can in
turn, foster independence and fortitude. Finally,
companionship support gives the recipient a sense of social
belonging. This type can be seen as the presence of companions in
a child's life to engage in shared social activities. All of
these forms of support can serve as protective factors to enhance
a child's resilience.
The Adverse Childhood Events Study has shown that childhood
community resilience assets, specifically, one, being treated
fairly, two, supportive childhood friends, three,
opportunities for a child to enhance his or her abilities, four
access to a trusted adult, and five, having someone to look up
to, were independently linked to better outcomes in adulthood.
Last of the three aforementioned protective factors, internal
strength, represents the children's ability to cope with
challenges to persevere through adversity and to forge on
towards a specific goal.
Resilience during the pandemic. The COVID-19 pandemic is a
universal stressor faced by families in 2020 and into 2022.
The pandemic has brought emotional, physical, financial,
and psychological stress to families and the challenges have
impacted children in unique ways. Children have been
isolated from their peers, they have had to pursue their
education activities at home, they have had special events,
entire athletic seasons, and vacations canceled. Many parents
have faced financial hardships and subsequent food, housing,
and clothing insecurity which has also affected children. We
as adults have suffered. But think about how much more
difficult this has been on a child with less experience in
coping with adversity.
Resilience can be an incredible ally in a year like this one for
all of us. The unrelenting and unpredictable nature of the
pandemic's effect on our lives illustrates the need to foster
resilience within children and families before the onset of
stressors. The volatility of this year's events highlights
our need as pediatricians to evaluate the current degree of
resilience children and families possess, which can easily be
ascertained from basic check-in questions at a primary care
visit and to increase each family's preparedness to handle
stressful experiences in a targeted therapeutic manner.
What can we do? We as pediatricians can cultivate
resilience by helping children to use protective factors to
navigate through a stressful situation. For example, when a
child goes through the loss of a parent, we can encourage the
support of other caregivers, other social connections, and
community resources, to help the child to grieve appropriately,
and to return to an emotionally and physiologically stable
baseline. We can provide timely reminders about the benefits of
exercise, eating right, and getting enough sleep and
improving our ability to deal with stress.
Grief can be a long process for children, they often need
extended support from loved ones, school and even
professional therapy. These supportive systems are crucial
to ensure that the child has enough protective factors to
prevent long-term negative outcomes. As a pediatrician, you
have the power to impact the lives of patients and families
and mitigate the inevitable stress that many faced during
the pandemic. Talk to the patients and families and assess
parental knowledge of child development and the child's
social and emotional competence. Help them to increase their
protective factors, parental reassurance, social support, and
the child's internal strength. As a stable, caring adult in
your patient's life, you are a protective factor and can
continue to provide support as you care for them. Thank you for
watching this video on cultivating resilience in
children during and after the COVID-19 pandemic.